Individual
MR. ROGER EARL LOCKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
75 PHELAN AVE, #1, SAN JOSE, CA 95112-6120
(408) 279-3955
(408) 259-4350
Mailing address
75 PHELAN AVE, #1, SAN JOSE, CA 95112-6120
(408) 279-3955
(408) 259-4350
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
SR GH 26792253
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SR GH 26792253
SELLER'S PERMIT
CA
Enumeration date
12/20/2006
Last updated
07/08/2007
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